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Medial Collateral Ligament Reconstruction

Medial Collateral Ligament (MCL) Reconstruction

One of the most commonly injured ligaments of the body is the medial collateral ligament (MCL) of the knee. The majority of MCL injuries are a result of force to the knee and is commonly seen with athletes that end up injuring the ligament due to twisting or bending of the knee in the wrong direction, or a sudden change in direction.

Proper equipment like knee braces in contact sports can help prevent an injury, but they are not commonly used prophylactically because it can hinder performance.

Despite the amount of MCL injuries, treatments can be successful by utilizing non-operative management with the majority of the injuries. Comparable results are found with both non-operative and operative management of the specific injury. Patients who may have a combined injury of the ACL and MCL can anticipate average stability with a fair to excellent outcome with the functionality of the separated ACL reconstruction alone.

Superficial MCL Reconstruction

A knee dislocation that results in injuring both lateral and medial sides of the knee may demand superficial MCL reconstruction with close to 85% of the patients. There is a small but compelling amount of patients that will continue to experience symptoms of instability, pain, or both, following the MCL injury and demand surgical reconstruction. The treatment of MCL injuries has continued to evolve over the years from being an aggressive type of surgical treatment, to one that is mostly non-operation management.

These surgeries usually only are reserved for those who suffer from chronic MCL deficiency, which can be the result of more complex injuries, or a nonoperative treatment that has failed. The majority of those who suffer from an MCL injury will generally obtain their pre-injury activity level by utilizing the non-operation treatment. The exception for this is with those who have combined ligament injuries, which may necessitate acute operative care.

Grades of Acute Isolated MCL Injuries

There are three different grades used in order to classify the severity of the MCL injury. For instance:

Grade I – Involves only a few fibers being torn and can result in some tenderness.

Grade II – Includes more fibers being disrupted with a generalized tenderness.

Grade III – Is when there is a complete MCL tear.

A classification of grade I and II indicates an incomplete tear or injury, and is treated by utilizing non-operation management. This type of treatment mainly focuses on rest, compression, cryotherapy, and elevation during the acute phase. The primary goal for this type of injury is to reduce pain and the amount of swelling. The patient is allowed to put as much tolerated weight on the affected knee, but is required to wear a knee brace that hinges, in order to protect the knee from any type of additional stress.

In the early stages of the injury, early active range of motion is introduced in order to prevent stiffness for strengthening exercises. Once the patient’s proprioception and strength have recovered to a level comparable to the uninjured knee, they are then cleared to participate in their regular activities. A grade III classification is a complete MCL tear, and treatment for this type of injury is much more controversial compared to a grade I or II injury.

Research has provided thorough evidence to support both the operative and non-operative treatment procedures for grade II and III type of MCL injury. Originally, the operative treatment procedure was encouraged mainly due to inferior initial results of the non-operative treatment.

However, in subsequent comparison studies of both treatment methods, there were no objective or subjective differences found with the non-surgically and surgically managed groups, and many doctors tend to prefer the non-operative method with these types of isolated injuries. It is extremely important not to rule out any other ligament injuries to the knee and ensure that the MCL injury is definitely an isolated occurrence.

Combined Acute MCL and ACL Injuries

With a combination of both grade I or grade II classification for MCL and ACL injuries, in most cases the non-operative treatment method is still utilized, along with ACL reconstruction once the proper amount of knee motion has been achieved. The purpose of this treatment method when injuries to the MCL and ACL are combined is to avoid stiffness in the knee, and a delay with the reconstruction of the ACL can help reduce this type of complication.

For a combined MCL and ACL injury that is classified as a grade III, the MCL is still generally treated using the non-operative method, followed up with ACL reconstruction. With patients that have experienced this type of injury, the knee is set in a brace for six weeks, followed by strength and motion exercises once the MCL has had adequate time to heal.

However, if instability continues after the six week period with the brace, a surgical treatment will usually be recommended for the MCL, in combination with the ACL reconstruction. After reconstruction of the MCL and ACL, the patient is then made non-weight bearing while locked in extension. Approximately three weeks after the reconstruction procedure the Romberg test (ROM) is initiated to evaluate cerebellar function and balance.

While the MCL is the most commonly injured ligament of the knee, it continues to be a topic of emerging surgical, clinical, and rehabilitative research. With current knowledge and continuous research regarding the anatomy of the knee and treatment procedures, excellent outcomes have been reported for both the non-operative and operative treatment methods.

One of the top sports medicine doctors in Scottsdale and Phoenix is Dr. Sumit Dewanjee at FXRX. Dr. Dewanjee is Fellowship Trained in all types of simple and complex ligament reconstruction.

He is highly skilled in minimally invasive knee surgery with arthroscopic techniques. Most insurance is accepted, call (480) 449-3979 today!

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Testimonials

I could not be more pleased with this practice!! I brought my 4 year old son in with a broken arm and was given exceptional same day service. The entire staff was so kind, understanding, attentive, and professional.

The office manager Lindy is a dream! Dr. Dewanjee is fantastic! I have brought my son in for two unrelated incidents and he has treated him so kindly. My dad sees Dr. Dewanjee as well and is so impressed. He is truly a 5 Star Doctor and I am so appreciative to he and his staff.

Jill S.

If you are planning to have orthopedic surgery Please do yourself a favor and call
Dr. Dewanjee's office. I interviewed four doctors and found what we believe is the best surgeon for our son's surgery. When calling in ask for Lindey (sp) she is the best in the front office. She will walk you through the whole scheduling to getting you that consult with Dr. Sumit Dewanjee.

His beside manners are professional but easy, he made you feel that his full attention and expertise was given before, during and after the surgery.
Please do yourself a favor and just call to get that consult and see how calming Dr. Dewanjee is on a very stressful operation.
Thank you so much for doing what we believe is a top notch job!

A. Baca

I am grateful to have found such a skilled and compassionate surgeon. For years I feared the two total knee joint replacement surgeries I needed, thus I put them off for as long as possible.

Dr. Dewanjee was professional, kind, and reassuring. And I now walk with a straight leg that bends at the knee like it should.

I'd like to thank Dr. Dewanjee for his surgical expertise, kindness, and compassionate care. Please know that I think so highly of Dr. Dewangee that I refer many friends to him and even strangers I have met with knee problems.

Dr. Dewanjee has a gift as a surgeon and I am blessed to have benefited from his expertise. I'm now looking forward to my right knee replacement with Dr. Dewanjee as it will only enrich my quality of life."

Julie Jacobs

"In January I was involved in a horse riding accident which left me with several broken bones including a badly fractured clavicle. As a Canadian I had heard horror stories about the American medical system; my experience, however, was wonderful.

Within 24 hours of the accident I had an appointment with an orthopedic specialist, Dr. Sumit Dewanjee. His staff was professional, friendly and caring, making the whole process of being a Canadian in the American medical system as simple as possible. They dealt with all the paperwork which made the situation much easier for me.

Dr. Dewanjee is a very personable and skilled professional. He laid out my options very clearly and recommended the surgery I ended up having. The surgery was very successful.

I was made to feel like a valued patient as Dr Dewanjee carefully and fully answered all my questions and concerns. I would highly recommend Dr. Dewanjee and his entire staff to anyone wanting excellent care and a successful surgical experience."

"During my Freshman year of college I dislocated my shoulder during a basketball game. After being referred to Dr. Sumit Dewanjee I wouldn't ask for a better doctor. He listens to his patients with depth that insures security. He performed surgery on my shoulder. During my visits to his office, Dr. Dewanjee and his staff were very customer oriented and organized. Within six months I was playing basketball again. I would definitely recommend Dr. Dewanjee."

Candace Jackson

I had a significant shoulder injury and after Dr. Dewanjee performed my surgery, i was back to work in minimal time. His intelligence along with his experience and knowledge to correctly repair my injury was paramount.

If you have a shoulder or knee injury, I would recommend Dr. Dewanjee at FXRX more highly than any other doctor.

Thank you Dr. Dewanjee!

Jim M, Phoenix

When I considered total knee replacement, like most people, I was anxious, but when I met
Dr. D, he was very reassuring. I did not feel rushed during our discussion or when scheduling surgery. My surgery went very well, I was up and walking soon. I am walking my dogs again and feeling stronger in both legs. I have respect for Dr. D not only as a surgeon, but as a kind and caring person.